Allied Health Durable Medical Equipment and Medical Supplies

New Claim Form Submission Reminders

The following are reminders for correctly submitting the new CMS-1500 claim form:

  • CMS-1500 claim forms with bar codes are not acceptable.
  • CMS-1500 claim forms must be printed on scanner-quality paper. Forms printed on low-quality or thin paper are not acceptable, as they tear easily during the scanning process.
  • Original claim forms must be submitted. Copies will not be accepted.
  • All provider information fields must be completed.
  • Claim information must be properly entered within the borders of the appropriate area or box. Claims with the information in the middle or outside of a border may be rejected.
  • The Medi-Cal provider number must be entered in Box 33B through November 25, 2007. Claims without the Medi-Cal provider number in Box 33B will not be processed. The National Provider Identifier (NPI) should be entered in Box 33A. Beginning November 26, 2007, the NPI will be the only identifier accepted on claim forms, and must be entered in Box 33A.

Note:The only exceptions to the NPI requirement are atypical providers (blood banks, Christian Science practitioners and Multipurpose Senior Services Program providers).

Rate Adjustment for Power Wheelchair Codes

Effective for dates of service on or after August 1, 2007, the rental and purchase rates for power wheelchair HCPCS codes K0830 (Group 2, standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds) and K0831 (Group 2 standard, seat elevator, captain’s chair, patient weight capacity up to and including 300 pounds) have been revised as follows:

HCPCS CodeRental RatePurchase Rate

K0830$391.41$4,696.92

K0831$391.41$4,696.92

This information is reflected on manual replacement page dura cd 12 (Part 2).

DME1

Medi-Cal Update – Billing and PolicyAugust 2007

Effective Date Change for Specific Power Operated Vehicle and Wheelchair Base Codes

In the July Medi-Cal Update, billing restrictions were published for power operated vehicle HCPCS code E1230 and power wheelchair HCPCS codes E1239, K0010, K0011, K0012 and K0014, effective for dates of service on or after September 1, 2007. The effective date for these billing restrictions has been changed.

Effective for dates of service on or after November 1, 2007, reimbursement for these codes is restricted to repair only (except when K0011 is used to bill for an iBOT wheelchair). Claims billed with modifier RP must include documentation that the repair is for patient-owned equipment. Any claims for the rental (code billed with modifier RR) or purchase (code billed with modifier NU) of these codes (except as noted for an iBOT with code K0011) for dates of service on or after
November 1, 2007 will be denied.

This information is reflected on manual replacement pages dura bil wheel 4 and 10 (Part 2).

Rate Increase for Power Wheelchair Joystick

Medicare has updated the reimbursement rate for HCPCS code E2374 (power wheelchair accessory, hand or chin control interface, standard remote joystick [not including controller] proportional, including all related electronics and fixed mounting hardware, replacement only). In accordance with statute, Medi-Cal has adjusted the rate for this purchase-only item from $169.36 to $534.02, effective for dates of service on or after August 1, 2007.

This information is reflected on manual replacement page dura cd 24 (Part 2).

Incontinence Supply Changes: Disposable Underpads

The Department of Health Care Services (DHCS) recently negotiated contracts with manufacturers to obtain a maximum acquisition cost (MAC) for disposable underpad products. The price established by these contracts sets the maximum amount that a Medi-Cal provider will pay and/or be reimbursed for these products. Only listed underpad products are benefits.

Incontinence Supply Updates

Effective for dates on or after September 1, 2007, the following medical supply product codes have been added for disposable underpad products:

CPT-4 CodeDescription

9900MUnderpads with core mat area size less than or equal to 675 square inches

9900NUnderpads with core mat area size 676 to 825 square inches

9900PUnderpads with core mat area size equal to or greater than 826 square inches

9900QBreathable underpads

The following medical supply codes will be discontinued as of November 1, 2007:

9988D, 9988G, 9988H, 9988J, 9988L, 9988M, 9998G, 9998H, 9998J, 9998K, 9998L,
9998M, 9998Q, 9998R, 9998S, 9998T

The products and product codes with the maximum allowable amounts and prior authorization limitations are listed in the Incontinence Products section of the Part 2 manual.

Please see Incontinence, page 3

DME1

Medi-Cal Update – Billing and PolicyAugust 2007

Incontinence (continued)

Billing Transition

Effective for dates of service on or after September 1, 2007, the new underpad product codes and pricing will be implemented. Providers may begin billing these products using the new product codes on September 1, 2007. Effective for dates of service on or after November 1, 2007, the old products and supply codes will no longer be reimbursable. Providers who have obtained Treatment Authorization Requests (TARs) for non-contracted items prior to November 1, 2007 will be allowed to continue billing these items until their TAR authorization has been exhausted.

Manufacturer Billing Code Update

Effective for dates of service on or after September 1, 2007, the following billing codes have been added.

Manufacturer Billing CodeManufacturer Name

3DAbsorbent Products Company, Inc.

3BIdeal Brands, Inc.

This information is reflected on manual replacement pages incont ap 2 (Part 2), incont lst 2 and 22 thru 25 (Part 2) and incont prod 1 thru 5 (Part 2).

Contract Drugs List Available at Epocrates, Inc.

Effective June 13, 2007, the Contract Drug Lists for the Medi-Cal program and the AIDS Drug Assistance Program (ADAP) became available online to healthcare professionals through Epocrates, Inc. Access to Medi-Cal and ADAP formularies is free to healthcare providers. For access and free downloads to mobile devices, visit .

CCS Service Code Groupings Update

Retroactive for dates of service on or after July 1, 2007 a number of codes are end-dated and added to California Children’s Services (CCS) Service Code Groupings (SCGs) 01, 02, 03, 04, 05 and 07.

Effective for dates of service on or after August 1, 2007, an additional number of codes are end-dated and added to CCS SCGs 01, 02, 03 and 10.

Reminder:SCG 02 includes all the codes in SCG 01; SCG 03 includes all the codes in SCG 01 and SCG 02; and SCG 07 includes all the codes in SCG 01. These same “rules” apply to end-dated codes.

The updated information is reflected on manual replacement pages cal child ser 1, 3, 6, 7, 11,
14 thru 16 and 22(Part 2).

DME1

Instructions for Manual Replacement PagesPart 2

August 2007

Durable Medical Equipment and Medical Supplies Bulletin 383

Remove and replace:Contents for Durable Medical Equipment and Medical Supplies Billing and Policy iii/iv *

appeal form 1/2 *

cal child ser 1 thru 8, 11 thru 16, 21/22

cms comp 15/16 *

dura bil wheel 3/4, 9/10

dura cd 11/12, 23 thru 26

incont ap 1/2

incont lst 1/2, 21 thru 26

Insert after the
Incontinence
Medical Supplies
Product List section:incont prod 1 thru 5 (new)

Remove and replace:mc sup lst1 15/16 *

The July Medi-Cal Update incorrectly instructed providers to remove and replace ortho 1/2, 9 thru 15. Please disregard. This section is not part of the Part 2 Durable Medical Equipment and Medical Supplies manual.

*Pages updated due to ongoing provider manual revisions.